Columbus Regional Healthcare System, The Medical Center, Columbus, GA 31902, USA.
Am Fam Physician. 2011 Mar 15;83(6):711-6.
Statins play an important role in the care of patients with cardiovascular disease and have a good safety record in clinical practice. The risk of hepatic injury caused by statins is estimated to be about 1 percent, similar to that of patients taking a placebo. Patients with transaminase levels no more than three times the upper limit of normal can continue taking statins; often the elevations will resolve spontaneously. Coexisting elevations of transaminase levels from nonalcoholic fatty liver disease and stable hepatitis B and C viral infections are not contra- indications to statin use. Although myalgias are common with statin use, myositis and rhabdomyolysis are rare. When prescribed at one-half the recommended maximal dosage or less, statins are associated with an incidence of myopathy similar to that of placebo; therefore, rou- tine monitoring of creatine kinase levels in asymptomatic patients is not recommended. Myopathic symptoms usually resolve approximately two months after discontinuing the statin, and the same statin can be restarted at a lower dosage, or patients can try a different statin. Clinically important drugs that interact with statins and increase the risk of adverse effects include fibrates, diltiazem, verapamil, and amiodarone.
他汀类药物在心血管疾病患者的治疗中发挥着重要作用，在临床实践中有良好的安全性记录。他汀类药物引起肝损伤的风险估计约为 1%，与服用安慰剂的患者相似。转氨酶水平不超过正常上限三倍的患者可以继续服用他汀类药物；升高通常会自发消退。非酒精性脂肪性肝病和稳定的乙型和丙型肝炎病毒感染共存的转氨酶水平升高不是使用他汀类药物的禁忌症。尽管他汀类药物使用常伴有肌痛，但肌炎和横纹肌溶解症很少见。当以推荐最大剂量的一半或更低剂量开处方时，他汀类药物与肌病的发生率与安慰剂相似；因此，不建议对无症状患者常规监测肌酸激酶水平。肌病症状通常在停用他汀类药物后约两个月内消退，同一种他汀类药物可以以较低剂量重新开始使用，或者患者可以尝试使用不同的他汀类药物。与他汀类药物相互作用并增加不良反应风险的临床重要药物包括贝特类药物、地尔硫卓、维拉帕米和胺碘酮。
